5 ms·

We're back: How tuberculosis is set to surge globally once again

82 points by pseudolus 2y ago

superkuh 2y ago
Bruce Sterling's "Heavy Weather" was a surprisingly accurate prediction of the 2020-2040s for coming out in 1995 at the peak of "the end of history". He called this one re: tuberculosis.
yimby2001 2y ago
[dead]
madhacker 2y ago
[flagged]
- deleted 2y ago
  [deleted]
- coolThingsFirst 2y ago
  [flagged]
sepositus 2y ago
This was an enlightening article (as I wasn't too familiar with the history of TB), but I'm struggling to grasp the overall point. If USAID is all that's standing between us and TB taking over the world, that's a _seriously_ lousy place to be in. Why are we not spending time talking about resolving that issue instead? You could argue that restoring USAID gives us more time to resolve the issue, but then I would ask what has been happening during the time the funding was active? Maybe I misunderstood the author's assertion.
- staticautomatic 2y ago
  It’s systemically really hard to treat TB in places without a lot of health infrastructure. USAID can mitigate this but it doesn’t follow that “more USAID” can eradicate TB.
- tekla 2y ago
  Current TB vaccines and treatments are not incredibly effective against it. The effort is toward not letting it get so much worse than it already is by aggressively fighting it with the mediocre tools we have.
- freen 2y ago
  The answer to the problem of the US’s work as only mitigating, rather than solving is not abandonment: it is true leadership and collaboration. Smallpox, the hole in the ozone layer, etc. It is possible. Shrinking away because you can’t fully solve it alone or others aren’t helping as much as you’d like? Cowardice and/or avarice to a degree that is, in my humble opinion, indistinguishable from evil.
  - sepositus 2y ago
    > it is true leadership and collaboration This is a great outlook, but I think it's slightly short-sighted if you don't consider that there are several ways to achieve the same outcome outside of USAID. I think the US can lead the world through public example rather than trying to set that same example through the government. For example, I treat my charitable donations with the same seriousness that I apply towards my 401k. I am researching organizations, determining their overall efficacy, and splitting my funds to where I think they would be the most beneficial, given the current global climate. I would love to see this principle applied more broadly to the public. There might be services out there that already provide such "charity portfolios," but I'll admit that I'm pretty content doing it myself, so I haven't looked much. But, given our government's history of mismanagement, I think this sort of approach would have far more impact than funneling everything through a large organization like USAID.
    - freen 2y ago
      This (cost/benefit analysis of non-profits, mutual fund type investment vehicles for non-profits, etc. take a look at social impact bonds, Robin Hood Foundation, etc. ) has existed for ages, and they vastly underperform us govt agencies in terms of $/outcomes for reasons that should be obvious: economies of scale. There are very few ngo agencies that outperform the us government, and usually they operate in fields/domains that the government can’t because of political risk aversion: the voting public doesn’t like drug addicts treated like humans, and vote out politicians who do. The single most effective non-profit dollar for dollar in terms of saving lives is UNICEF. It is extremely easy to say the government is mismanaged/inefficient. It’s been basically the consistent drumbeat for centuries. Yet, once “reformers/efficiency/deficit hawks” take power, they discover quite quickly (if they are keen on retaining their positions) that the current state of affairs is deeply imperfect, but perfection is impossible. What folks fail to realize is that government operates under EXTREMELY DIFFERENT CONSTRAINTS and extremely different capabilities than businesses or individuals. They have totally different goals! Turns out, predictability > efficiency. Because people can make long term investments against predictability. Inefficiency, below a certain threshold of course, gets priced in as a fixed cost, and business routes around it/operates around it.
- ZeroGravitas 2y ago
  I'm not sure th article had a singular point, it was more like a book review with some topical references. The author of the book suggested in a YouTube video (based on his contacts in the medical teams) that the sudden and unexpected cut of USAID funds led to people half way through TB treatment being abandoned which is entirely unnecessary even if you strongly politically believe that the US should not be doing this and increases the risk of new strains mutating.
- hamaluik 2y ago
  Everything is Tuberculosis [1] answers just that. Essentially it boils down to staggering wealth inequality and the aftershocks of colonialism . The west “cured” TB 70 years ago then stopped caring about it. There isn’t a enough profit in preventing a million deaths a year in the rest of the world, so we just.. don’t. [1]: https://everythingistb.com/ https://everythingistb.com/
  - tekla 2y ago
    Oh yes, the billions of dollars and decades of work specifically for the 3rd world to fight TB never happened and the cash was burned in a big bonfire.
  - sepositus 2y ago
    The premise sounds interesting, but it seems a bit reductionist if it boils down to that, no? Is the book looking at it through the lens of government actions or private charities? I'm not aware of any evidence that suggests charities simply stopped operating because of capitalism.
    - hamaluik 2y ago
      The book includes privates charities and governments, but looks at TB through many more lenses than just those. There is a reason it’s a whole book and not just a comment on an Internet forum. I just finished the book and highly recommend the read, if only to learn about something that I suspect most of us (myself at least, certainly), is known only as _history_, not the raging health crisis that is continues to be.
      - sepositus 2y ago
        Sounds interesting, I'll add it to my list. Appreciate the response.
OutOfHere 2y ago
People can have latent TB, which causes no symptoms and is not contagious. If it reactivates, it can cause permanent damage to the lungs and/or other areas such as the bones, joints, kidneys, and brain. Diagnosis and treatment are important just the same. Lazy doctors can miss out on testing for TB when the lungs appear clear, with symptoms present in just the lymph nodes, bones, joints, kidneys, or brain, indicating possible extrapulmonary TB.
jmclnx 2y ago
Well Trump does not care about the WHO and what is says, didn't he force the US to leave the WHO. And yes, his cuts will ensure TB and many other once close to extent diseases come back. Just look at measles in the South.
inglor_cz 2y ago
Poorer countries and generally countries with worse governance have a real trouble controlling tuberculosis. Given how much of it is asymptomatic, you have to have a real screening program including X-rays in order to catch cases, and that is beyond the ability of most developing countries - which are precisely the countries where most of the population boom is taking place. I don't believe that USAID can cover, say, the whole of Africa with preventative care. The US cannot cover even all of its own citizens, for a host of reasons, much less 1,5 billion people in exotic regions far from its borders. Purge of USAID is likely to make the situation worse, but only marginally worse. The real problem is that at least third of humanity doesn't yet have any reasonable healthcare infrastructure, reliable grid (for medical machines to work), public safety (for doctors to survive), etc., etc., etc. If we had a functional recipe to solve such problems, they would likely be solved already.
- leoh 2y ago
  > Purge of USAID is likely to make the situation worse, but only marginally worse Do you have a degree in public health?
  - inglor_cz 2y ago
    What? About a quarter of the entire humanity is infected with TBC bacteria. Two billion people, often in the most remote and poorest places in the world, like Niger or Afghanistan. You don't have to be a public health professional to calculate that USAID can put a dent to this massive problem, but cannot even dream about reducing it to, say, half of its current size.
    - pixxel 2y ago
      The answer was, no.
    - leoh 2y ago
      >but only marginally worse My point is that I don't think OP is qualified to say whether or not USAID is putting a meaningful dent in the TB problem. It's entirely possible that, for example, if you deploy resources amongst individuals that are known to travel, for example, you could significantly eliminate the probability of others being infected (including you and I in the developed world).
aaron695 2y ago
[dead]
JeremyStinson 2y ago
>"Even after treatments emerged to combat TB, their geographic availability revealed the prevalence of prejudice. Starting in the 1980s, the emergence of HIV/AIDS *allowed TB to spread more quickly through weakened immune systems*" This is the statement that stood out to me. We've had 5 years of weakening immune systems, which has, with a high probability, contributed further to the spread of TB. History is repeating, again.

82 points by pseudolus 2y ago

Bruce Sterling's "Heavy Weather" was a surprisingly accurate prediction of the 2020-2040s for coming out in 1995 at the peak of "the end of history". He called this one re: tuberculosis.

yimby2001 2y ago

[dead]

madhacker 2y ago

[flagged]

deleted 2y ago
[deleted]
coolThingsFirst 2y ago
[flagged]

sepositus 2y ago

This was an enlightening article (as I wasn't too familiar with the history of TB), but I'm struggling to grasp the overall point. If USAID is all that's standing between us and TB taking over the world, that's a _seriously_ lousy place to be in. Why are we not spending time talking about resolving that issue instead? You could argue that restoring USAID gives us more time to resolve the issue, but then I would ask what has been happening during the time the funding was active? Maybe I misunderstood the author's assertion.

staticautomatic 2y ago
It’s systemically really hard to treat TB in places without a lot of health infrastructure. USAID can mitigate this but it doesn’t follow that “more USAID” can eradicate TB.
tekla 2y ago
Current TB vaccines and treatments are not incredibly effective against it. The effort is toward not letting it get so much worse than it already is by aggressively fighting it with the mediocre tools we have.
freen 2y ago
The answer to the problem of the US’s work as only mitigating, rather than solving is not abandonment: it is true leadership and collaboration. Smallpox, the hole in the ozone layer, etc. It is possible. Shrinking away because you can’t fully solve it alone or others aren’t helping as much as you’d like? Cowardice and/or avarice to a degree that is, in my humble opinion, indistinguishable from evil.
- sepositus 2y ago
  > it is true leadership and collaboration This is a great outlook, but I think it's slightly short-sighted if you don't consider that there are several ways to achieve the same outcome outside of USAID. I think the US can lead the world through public example rather than trying to set that same example through the government. For example, I treat my charitable donations with the same seriousness that I apply towards my 401k. I am researching organizations, determining their overall efficacy, and splitting my funds to where I think they would be the most beneficial, given the current global climate. I would love to see this principle applied more broadly to the public. There might be services out there that already provide such "charity portfolios," but I'll admit that I'm pretty content doing it myself, so I haven't looked much. But, given our government's history of mismanagement, I think this sort of approach would have far more impact than funneling everything through a large organization like USAID.
  - freen 2y ago
    This (cost/benefit analysis of non-profits, mutual fund type investment vehicles for non-profits, etc. take a look at social impact bonds, Robin Hood Foundation, etc. ) has existed for ages, and they vastly underperform us govt agencies in terms of $/outcomes for reasons that should be obvious: economies of scale. There are very few ngo agencies that outperform the us government, and usually they operate in fields/domains that the government can’t because of political risk aversion: the voting public doesn’t like drug addicts treated like humans, and vote out politicians who do. The single most effective non-profit dollar for dollar in terms of saving lives is UNICEF. It is extremely easy to say the government is mismanaged/inefficient. It’s been basically the consistent drumbeat for centuries. Yet, once “reformers/efficiency/deficit hawks” take power, they discover quite quickly (if they are keen on retaining their positions) that the current state of affairs is deeply imperfect, but perfection is impossible. What folks fail to realize is that government operates under EXTREMELY DIFFERENT CONSTRAINTS and extremely different capabilities than businesses or individuals. They have totally different goals! Turns out, predictability > efficiency. Because people can make long term investments against predictability. Inefficiency, below a certain threshold of course, gets priced in as a fixed cost, and business routes around it/operates around it.
ZeroGravitas 2y ago
I'm not sure th article had a singular point, it was more like a book review with some topical references. The author of the book suggested in a YouTube video (based on his contacts in the medical teams) that the sudden and unexpected cut of USAID funds led to people half way through TB treatment being abandoned which is entirely unnecessary even if you strongly politically believe that the US should not be doing this and increases the risk of new strains mutating.
hamaluik 2y ago
Everything is Tuberculosis [1] answers just that. Essentially it boils down to staggering wealth inequality and the aftershocks of colonialism . The west “cured” TB 70 years ago then stopped caring about it. There isn’t a enough profit in preventing a million deaths a year in the rest of the world, so we just.. don’t. [1]: https://everythingistb.com/ https://everythingistb.com/
- tekla 2y ago
  Oh yes, the billions of dollars and decades of work specifically for the 3rd world to fight TB never happened and the cash was burned in a big bonfire.
- sepositus 2y ago
  The premise sounds interesting, but it seems a bit reductionist if it boils down to that, no? Is the book looking at it through the lens of government actions or private charities? I'm not aware of any evidence that suggests charities simply stopped operating because of capitalism.
  - hamaluik 2y ago
    The book includes privates charities and governments, but looks at TB through many more lenses than just those. There is a reason it’s a whole book and not just a comment on an Internet forum. I just finished the book and highly recommend the read, if only to learn about something that I suspect most of us (myself at least, certainly), is known only as _history_, not the raging health crisis that is continues to be.
    - sepositus 2y ago
      Sounds interesting, I'll add it to my list. Appreciate the response.

OutOfHere 2y ago

People can have latent TB, which causes no symptoms and is not contagious. If it reactivates, it can cause permanent damage to the lungs and/or other areas such as the bones, joints, kidneys, and brain. Diagnosis and treatment are important just the same. Lazy doctors can miss out on testing for TB when the lungs appear clear, with symptoms present in just the lymph nodes, bones, joints, kidneys, or brain, indicating possible extrapulmonary TB.

jmclnx 2y ago

Well Trump does not care about the WHO and what is says, didn't he force the US to leave the WHO. And yes, his cuts will ensure TB and many other once close to extent diseases come back. Just look at measles in the South.

inglor_cz 2y ago

Poorer countries and generally countries with worse governance have a real trouble controlling tuberculosis. Given how much of it is asymptomatic, you have to have a real screening program including X-rays in order to catch cases, and that is beyond the ability of most developing countries - which are precisely the countries where most of the population boom is taking place. I don't believe that USAID can cover, say, the whole of Africa with preventative care. The US cannot cover even all of its own citizens, for a host of reasons, much less 1,5 billion people in exotic regions far from its borders. Purge of USAID is likely to make the situation worse, but only marginally worse. The real problem is that at least third of humanity doesn't yet have any reasonable healthcare infrastructure, reliable grid (for medical machines to work), public safety (for doctors to survive), etc., etc., etc. If we had a functional recipe to solve such problems, they would likely be solved already.

leoh 2y ago
> Purge of USAID is likely to make the situation worse, but only marginally worse Do you have a degree in public health?
- inglor_cz 2y ago
  What? About a quarter of the entire humanity is infected with TBC bacteria. Two billion people, often in the most remote and poorest places in the world, like Niger or Afghanistan. You don't have to be a public health professional to calculate that USAID can put a dent to this massive problem, but cannot even dream about reducing it to, say, half of its current size.
  - pixxel 2y ago
    The answer was, no.
  - leoh 2y ago
    >but only marginally worse My point is that I don't think OP is qualified to say whether or not USAID is putting a meaningful dent in the TB problem. It's entirely possible that, for example, if you deploy resources amongst individuals that are known to travel, for example, you could significantly eliminate the probability of others being infected (including you and I in the developed world).

aaron695 2y ago

[dead]

JeremyStinson 2y ago

>"Even after treatments emerged to combat TB, their geographic availability revealed the prevalence of prejudice. Starting in the 1980s, the emergence of HIV/AIDS *allowed TB to spread more quickly through weakened immune systems*" This is the statement that stood out to me. We've had 5 years of weakening immune systems, which has, with a high probability, contributed further to the spread of TB. History is repeating, again.